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Cosmetic Blepharoplasty upper and lower

Introduction

Understanding eyelid surgery

Droopy, puffy or baggy eyelids can make you look older, tired and can also impair vision. Surgery can correct these problems and refresh and redefine your appearance. A drooping brow is often a contributing factor or even the main cause of upper lid problems. Dr Lamb will assess whether the brow needs elevation and, if required, a brow lift will be performed at the same time as lid surgery.

Making the decision to have eyelid surgery

During the pre-operative consultation, you will be examined and asked questions about previous lid surgery, tear production, use of lenses, eye drops and your expectations of surgery. Dr Lamb will examine your eyes and eyelids to exclude any problems that could affect a good functional result. He will also demonstrate what to expect from eyelid surgery. Factors to be considered include age, skin type, ethnic background and degree of vision obstruction.

The function of the upper eyelid muscle (the ‘levator’) will be assessed and if the upper lid margin is lower than normal, surgery to tighten that muscle may also be necessary. This procedure, called ptosis surgery, should be performed at the same time as blepharoplasty, saving the patient from having two separate surgeries. If the muscle is weak, having lid surgery without ptosis repair will not fix the problem as the underlying muscle is still weak. This is a common source of referral to Dr Lamb when other doctors have performed blepharoplasty but not repaired the weak levator muscle that now requires a second operation.

In upper lid surgery, Dr Lamb marks the natural lines of the lids to make the scars virtually invisible along these natural folds. An incision is made and excess skin, muscle and fat are removed using a CO2 laser. The use of a laser greatly reduces swelling and bruising. Fine sutures are used to close the incisions, thereby minimising the visibility of any scar.

In lower eyelid surgery, two incisions are usually made. Using a CO2 laser, the first incision is made on the inside of the lower lid to remove excess fat. This does not leave a visible scar. The lower eyelid skin often requires tightening and is usually achieved by removing skin. This requires sutures just below the eyelashes in the natural crease of the lid and is usually invisible. CO2 laser resurfacing may be used when less tightening is required.

The muscles of the lower lid often are also loose and require tightening. These muscles are raised at the outer corners of the eye and secured, rather like lifting one end of a hammock. This is called a canthoplasty (also known as canthopexy) and tightens the lower lid. It also can be used to change the shape of the outer corner of the eye if desired.

Postoperative Instructions

No bending, lifting heavy objects or any strenuous exercises for ten days. Swelling is to be expected and can vary from mild to severe.  For the first two days, frequent use of a cold compress is recommended.  Take a clean bowl of cold water, add a clean facecloth, soak it in the cold water and squeeze it out.  Place the facecloth over the incision site.  When the cloth is no longer cool, rinse it again in the cold water.  You could also use Johnson & Johnson or Swisspers eye makeup removal pads in replacement of a facecloth.  A cold compress will reduce swelling and discomfort.

Do not use frozen peas, Cryo‑Gel™ Gel Packs etc. Use ONLY light cloths similar to what is supplied in theatre.

When lying down, use two to three pillows.  During the day, it is best to keep moderately active.  Lying down during the day will increase the swelling. You may take Paracetamol tablets if necessary for pain.

Risks

This procedure involves incisions on the outer surface on the upper lid and the inner surface and usually the outer surface of the lower lids.  Complications can occur, but are rare. Infection is always a possibility – however this is uncommon after lid surgery. Haemorrhage can occur and has the potential to affect eyesight, however with laser surgery this is very rare.  Dr Lamb has never seen this happen.   Damage to the muscle in the upper or lower lid can result in a droopy eyelid.  Precautions are taken for this not to occur but if it should occur, it can be repaired.  Damage to a muscle in the lower lid can result in double vision. This is rare and I have never seen this problem. If too much skin is taken from the upper eyelid, difficulty in closing the eye can occur.  With lower lid surgery, the lid can sit away from the eye usually due to swelling and usually settles quickly.  As the upper lid skin is incised, a scar may result.  The incision is in the lid crease and will fade with time.  However if one scars excessively it may be more prominent and require modification. Lid asymmetry can occur and may require modification.  If you have had filler in your lower lid area, it will have to be removed before surgery.  This requires injections of a dissolving agent.  If the filler is not hyaluronic acid it cannot be removed.  Even with this treatment prolonged swelling is possible due to residual filler. The laser can damage the eye if fired directly at it.  This should not occur as Dr Lamb uses specially designed eye shields to prevent this. Some discomfort, swelling and possibly bruising can occur, fluid can collect over the white of the eye and is usually transient, however this is minimised by the use of laser.